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  • Global Unmet Needs for Contraception,

    Reproductive Health and Justice

    John W Townsend Future of Contraceptive Initiative (FOCI)

    Meeting Seattle, Washington

    29 October 2011

  • Outline of Presentation

    Definition of unmet needs

    Unmet needs and MDGs

    Reasons for non-use of contraception

    Context of Unmet Need population growth, age structure and urbanization

    Implications for new products and services

    Potential risks

    Challenges for the future

  • Three perspectives on same Issue

    On October 31, the 7 billionth person, a girl, will be born in poverty in Africa or Asia

    On the same day, a young pregnant mother will have died due to post-partum hemorrhage in the next village

    During the same week, a woman is beaten by her spouse as she cannot conceive. He suspects that that she is infected with HIV

  • Right to Health

    Realization of the right to health requires the removal of barriers that interfere with individual decision-making on health-related issues and with access to health services, education and information, in particular on health conditions that only affect women and girls. Report of Special Rapporteur of the Human Rights Council, August 2011

  • Definition of Unmet Need and Magnitude of Expression

    Fertile sexually active women who do not want to get pregnant in next two years but are not using a contraceptive method -Survey

    About 215 million women (26%) in developing countries have unmet need for spacing or limiting

    These women account for 82% of all unintended pregnancies

  • Unmet need and Maternal Child Health: MDGs 4, 5 and 6

    MDG 5: 75% reduction in maternal mortality ratio and universal access to reproductive health by 2015

    Indicators for universal access

    Contraceptive prevalence rate Adolescent birth rate Antenatal care coverage Unmet need for family planning

    MDG 5 on maternal health, MDG 4 on child health and

    MDG 6 on HIV are linked on issues of unmet needs potential synergies with health system development

  • Why do unintended pregnancies

    happen?

    Unmet need: Non-use of contraception when sexually active and a pregnancy is not desired Switching or discontinuing a contraceptive method Incorrect use or method failure Unplanned sex Unwanted sex

    Non-consensual and/or violent sex Early marriage

  • Fertility Use of

    contraception

    Fertility

    preferences

    Unmet need,

    Unsatisfied

    demand

    Cost/benefits

    of children

    Costs

    of birth control

    Socioeconomic

    development

    and mortality

    decline

    Family planning

    programs

    Demand for

    birth

    control

    Analytic framework for the determinants of fertility

  • Planning status and outcome of all

    pregnancies in developing countries 2008

    Source: S. Singh et al Studies in Family Planning 41, 241-250 (2010).

    0

    20

    40

    60

    80

    100

    120

    Per

    cen

    t o

    f A

    ll P

    reg

    nan

    cies

    Pregnancy Planning Status

    Unintended

    Intended

    Pregnancy Outcome

    Abortion

    Unintended Birth

    Miscarriage

    Intended Birth

  • Reasons for non-use of contraception in SS Africa, SE Asia and South Central Asia

    22%

    21% 17%

    10%

    16%

    8% 4% 2%

    Health/Side Effects

    Infrequent Sex

    Postpartum/Breastfeeding

    Partner opposed

    Woman opposed

    No access/high cost

    Unaware of methods

    Perceived subfecund

  • Women with unmet need are diverse in goals but more likely to be young, poor and rural

    Sub-Saharan Africa

    49%

    68%

    56%

    70%

    58%

    59%

    62%

    68%

    46%

    64%

    49%

    70%

    58%

    0% 20% 40% 60% 80% 100%

    Urban

    Rural

    Nonpoor

    Poor

    35+

    25-34

    20-24

  • Unmet need declines in married women but can it be eliminated?

    18 16

    18

    26

    12 10

    11

    24

    0

    5

    10

    15

    20

    25

    30

    LAC N Africa & WAsia

    S & SE Asia SS Africa

    1990-1994

    2000-2005

    Source: Guttmacher, 2008

    % o

    f m

    arri

    ed w

    om

    en 1

    5-4

    9 w

    ith

    un

    met

    ne

    ed

  • Less developed regions: alternative population projections: 2005-2050 and components of

    population growth

    0

    1000

    2000

    3000

    4000

    5000

    6000

    7000

    8000

    9000

    1950 2000 2050 2100

    Po

    pu

    lati

    on

    siz

    e (

    mill

    ion

    s)

    Standard projection

    Effect of: - High fertility - Mortality, migration - Young age structure

  • Effect of Age Structure on Growth

  • Urbanization in sub-Saharan Africa

    In 2009 Africas total population exceeded one billion, of which 395 million (40%) lived in urban areas

    Africas population will increase 60% between 2010 and 2050, with the urban population tripling to 1.23 billion during this period

    Source: UNEP, 2010

  • Implications for Contraceptive Development and Product Use in Developing Countries

    New products with health benefits as side effects, and are easier to use, especially those compatible with infrequent sex, do not interfere with intercourse or necessarily involve partners

    Adaptations of current contraceptive approaches to make products more acceptable to young users, more accessible and affordable in diverse segments at scale

    Long-term investment in new modes of contraceptive action that do not cause systemic side effects, can be used on-demand but not at intercourse, and address multiple unmet needs, including prevention of HIV

  • Potential Outlets: Clinic , Pharmacy, and Community

  • Potential Risks of Pursuit of Elimination of Unmet Need

    Uncertain link between unmet need and demand at individual level

    Potential demand is uncertain and anticipated costs are too high

    Miss opportunities for integration with HIV, working with men in multiple roles, to support market development with private sector

    Risk of coercion to meet development goals

  • Challenges for the Future

    New methods that respond to needs and rights of women and men in developing countries

    Development of technologies that support health system development , RH justice and gender equity

    Products that address multiple purposes (MPTs): contraception, infection prevention, pleasure

    News financing strategies that support outreach in diverse market segments to complement and challenge public sector care systems

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